High blood cholesterol levels
Cholesterol is a fat (also called a lipid) that your body needs to work properly. Too much bad cholesterol in your blood can increase your chance of getting heart disease, stroke, and other problems.
Heart disease
Coronary heart disease is a narrowing of the blood vessels that supply blood and oxygen to the heart. Coronary heart disease (CHD) is also called co...
Read Article Now Book Mark ArticleStroke
A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack. " If blood flow is cut off for longer th...
Read Article Now Book Mark ArticleCommon medical terms for high blood cholesterol are lipid disorder, hyperlipidemia, or hypercholesterolemia, with the last being the most precise.
Causes
There are many types of cholesterol. The ones talked about most are:
- Total cholesterol -- all the cholesterols combined
- High density lipoprotein (HDL) cholesterol -- often called "good" cholesterol
- Low density lipoprotein (LDL) cholesterol -- often called "bad" cholesterol
For many people, abnormal cholesterol levels are partly due to lifestyle choices. This often includes eating a diet that is high in fat. Other lifestyle factors are:
Lifestyle choices
Your body needs cholesterol to work well. But cholesterol levels that are too high can harm you. In the US, blood cholesterol is most often measured...
Read Article Now Book Mark ArticleEating a diet that is high in fat
A healthy diet is an important factor in reducing your risk for heart disease.
Read Article Now Book Mark Article- Being overweight
Overweight
Overweight and obesity mean having a weight than is higher than what is healthy for a given height. A person may be overweight from extra muscle, bo...
Read Article Now Book Mark Article - Lack of exercise
Cholesterol producers
Cholesterol is a waxy, fat-like material that is found in all parts of the body. It comes from two sources: our liver produces it, and we consume it in animal products.
Some health conditions can also lead to abnormal cholesterol, including:
- Diabetes
Diabetes
Diabetes is a long-term (chronic) disease in which the body cannot regulate the amount of sugar in the blood.
Read Article Now Book Mark Article - Kidney disease
Kidney disease
Chronic kidney disease is the slow loss of kidney function over time. The main job of the kidneys is to remove wastes and excess water from the body...
Read Article Now Book Mark Article - Polycystic ovary syndrome
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is a condition in which a woman has increased levels of male hormones (androgens). Many problems occur as a result ...
Read Article Now Book Mark Article - Pregnancy and other conditions that increase levels of female hormones
- Underactive thyroid gland
Underactive thyroid gland
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This condition is often called underactive thyroid....
Read Article Now Book Mark Article
Medicines such as certain birth control pills, diuretics (water pills), beta-blockers, and some medicines used to treat depression may also raise cholesterol levels. Several disorders that are passed down through families lead to abnormal cholesterol and triglyceride levels. They include:
- Familial combined hyperlipidemia
- Familial dysbetalipoproteinemia
- Familial hypercholesterolemia
- Familial hypertriglyceridemia
Smoking does not cause higher cholesterol levels, but it can reduce your HDL (good) cholesterol.
Exams and Tests
Understanding cholesterol results - Animation
LDL cholesterol has gotten a bad reputation, and for very good reason. Having too much of this fatty substance in your blood can clog up your arteries, preventing blood from getting to your heart and out to where it's needed in your body. Checking your LDL levels can help your doctor spot high cholesterol before it can cause a heart attack or stroke. Let's talk today about LDL tests. LDL stands for low-density lipoprotein. Lipoprotein is a type of protein that transports cholesterol, as well as fats called triglycerides and lipids, in your blood. When you eat too many fatty, cholesterol-rich foods, LDL cholesterol can start to collect in your artery walls. That's one collection you don't want, because if a chunk of that gunk breaks loose and gets lodged in a blood vessel, you could end up having a heart attack or stroke. To check your LDL cholesterol level, you'll need to have a blood test. Your doctor may tell you not to eat or drink anything for 8 to 12 hours before the test, so you can get an accurate reading. During the test, your doctor will draw blood from one of your veins. The needle might sting a little bit, but the feeling shouldn't last for any more than a few seconds. So, how do you know that you have high LDL cholesterol? Well, your LDL cholesterol level (think L for Lousy) will usually be measured along with your HDL, or good cholesterol (think H for Healthy), as well as your triglycerides and your total cholesterol level. Together, these measurements are called a lipid panel. You want your LDL level to be at least below 130 mg/dl, but ideally less than 100 milligrams per deciliter. If you're at high risk of heart disease, it should be even lower than that - less than 70 milligrams per deciliter. And for folks of average risk of getting heart disease, anything over 160 is considered a high LDL level. If you do have LDL cholesterol, you could be at risk for heart disease. Now, some folks have high cholesterol because they have an inherited condition that causes high cholesterol. If your LDL is low, it may be because you're not eating a well-balanced diet or your intestines aren't absorbing the nutrients from the foods that you eat. Ask your doctor how often you should have your LDL, and total cholesterol levels, checked. Depending upon your heart disease risks, you may need to be tested more often. If your LDL cholesterol is high, ask your doctor about cholesterol-lowering medications, diet, and other ways to bring it back down into a normal range.
A cholesterol test is done to diagnose a lipid disorder. Different experts recommend different starting ages for adults.
- Recommended starting ages are between 20 to 35 for men and 20 to 45 for women.
- Adults with normal cholesterol levels should have the test repeated every 5 years.
- Repeat testing sooner if changes occur in lifestyle (including weight gain and diet).
- Adults with a history of elevated cholesterol, diabetes, kidney problems, heart disease, and other conditions require more frequent testing.
Cholesterol and triglyceride test - Animation
Maybe you've been eating fast food more often than you should, or you're not getting your recommended two-and-a-half hours of exercise each week. Or, it could be that you smoke, or your blood pressure is too high. Well, for whatever reason, you may be concerned about your risk of getting heart disease. Well, a few tests can help you learn that risk, so you can start making healthy lifestyle changes to reduce it. A coronary risk profile is a group of blood tests that measure your cholesterol and triglyceride levels. Why is it important to know these levels? Because if you have too much of these substances in your blood from eating foods like burgers and French fries, they can clog your arteries. Eventually your arteries can become so clogged that you'll have a heart attack or stroke. Men should have their cholesterol tested by the time they're 35. Women should have it checked by age 45. If you have a condition like diabetes, heart disease, stroke, or high blood pressure, have your cholesterol checked now, no matter what your age. To measure your cholesterol, your doctor will give you a blood test. If you're also having your triglyceride level checked, you may be told not to eat or drink anything for 8 to 12 hours before the test. Depending upon your heart risk, the doctor may measure just your total cholesterol level, or your total cholesterol along with your LDL, or bad cholesterol, HDL, or good cholesterol, and triglycerides. If you're of average risk of getting heart disease, your goal is to have total cholesterol of less than 200 milligrams per deciliter, LDL cholesterol lower than 130 milligrams per deciliter, HDL cholesterol higher than 40 milligrams per deciliter if you're a man, or 50 if you're a woman -- the higher the better, and triglycerides of less than 150 also, the lower the better. Although some illnesses, like arthritis, can raise your cholesterol level, generally having high cholesterol means that you're at increased risk for heart disease and stroke. It's a sign you need to work harder to keep your heart healthy. If your cholesterol levels are normal, that's great! That means that you're eating right, you're exercising, and you're taking good care of your health. You don't need to have another cholesterol test for about five years. But if your cholesterol level is high, or you've already got heart disease, high blood pressure, or diabetes, you'll need to have your cholesterol levels checked more often. Keeping close tabs on your cholesterol and triglyceride levels is one way that you can take charge of your health, and change it for the better.
It is important to work with your health care provider to set your cholesterol goals. Newer guidelines steer providers away from targeting specific levels of cholesterol. Instead, they recommend different treatments or medicines and doses depending on a person's history and risk factor profile. These guidelines change from time to time as more information from research studies becomes available.
General targets are:
- LDL: 70 to 130 mg/dL (1.81 to 3.37 mmol/L) - lower numbers are better
- HDL: More than 60 mg/dL (1.55 mmol/L) or higher - higher numbers are better
- Total cholesterol: Less than 200 mg/dL (5.18 mmol/L) - lower numbers are better
- Triglycerides: 10 to 150 mg/dL (0.11 to 1.69 mmol/L) - lower numbers are better
Cholesterol
Cholesterol is a soft, waxy substance that is present in all parts of the body including the nervous system, skin, muscle, liver, intestines, and heart. It is made by the body and obtained from animal products in the diet. Cholesterol is manufactured in the liver and is needed for normal body functions including the production of hormones, bile acid, and Vitamin D. Excessive cholesterol in the blood contributes to atherosclerosis and subsequent heart disease. The risk of developing heart disease or atherosclerosis increases as the level of blood cholesterol increases.
If your cholesterol results are abnormal, you may also have other tests such as:
- Blood sugar (glucose) test to look for diabetes
Blood sugar (glucose) test
A blood sugar test measures the amount of a sugar called glucose in a sample of your blood. Glucose is a major source of energy for most cells of the...
Read Article Now Book Mark Article - Kidney function tests
Kidney function tests
Kidney function tests are common lab tests used to evaluate how well the kidneys are working. Such tests include:BUN (Blood urea nitrogen) Creatinin...
Read Article Now Book Mark Article - Thyroid function tests to look for an underactive thyroid gland
Thyroid function tests
Thyroid function tests are used to check whether your thyroid is working normally. The most common thyroid function tests are:Free T4 (free thyroxine...
Read Article Now Book Mark Article
Treatment
Steps you can take to improve your cholesterol levels and to help prevent heart disease and a heart attack include:
- Quit smoking. This is the single biggest change you can make to reduce your risk of heart attack and stroke.
Quit smoking
There are many ways to quit smoking. There are also resources to help you. Family members, friends, and co-workers may be supportive. But to be su...
Read Article Now Book Mark Article - Eat foods that are naturally low in fat. These include whole grains, fruits, and vegetables.
- Use low-fat toppings, sauces, and dressings.
- Avoid foods that are high in saturated fat.
Saturated fat
Saturated fat is a type of dietary fat. It is one of the unhealthy fats, along with trans fat. These fats are most often solid at room temperature....
Read Article Now Book Mark Article - Exercise regularly.
- Lose weight if you are overweight.
Your provider may want you to take medicine for your cholesterol if lifestyle changes do not work. This will depend on:
- Your age
- Whether or not you have heart disease, diabetes, or other blood vessel problems
- Whether you smoke or are overweight
- Whether you have high blood pressure or diabetes
High blood pressure
Blood pressure is a measurement of the force exerted against the walls of your arteries as your heart pumps blood to your body. Hypertension is the ...
Read Article Now Book Mark Article
You are more likely to need medicine to lower your cholesterol:
Medicine to lower your cholesterol
Your body needs cholesterol to work properly. But extra cholesterol in your blood causes deposits to build up on the inside walls of your blood vess...
Read Article Now Book Mark Article- If you have heart disease or diabetes
- If you are at high risk for heart disease (even if you do not yet have any heart problems)
- If your LDL cholesterol is 190 mg/dL (4.92 mmol/L) or higher
Almost everyone else may get health benefits from LDL cholesterol that is lower than 160 to 190 mg/dL (4.14 mmol/L to 4.92 mmol/L).
There are several types of drugs to help lower blood cholesterol levels. The drugs work in different ways. Statins are one kind of drug that lowers cholesterol and has been proven to reduce the chance of heart disease. Other drugs are available if your risk is high and statins do not lower your cholesterol levels enough. These include ezetimibe and PCSK9 inhibitors.
Outlook (Prognosis)
High cholesterol levels can lead to hardening of the arteries, also called atherosclerosis. This occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques.
Hardening of the arteries
Atherosclerosis, sometimes called "hardening of the arteries," occurs when fat, cholesterol, and other substances build up in the walls of arteries. ...
Read Article Now Book Mark ArticleDevelopmental process of atherosclerosis
The development of arterial atherosclerosis may occur when deposits of cholesterol and plaque accumulate at a tear in the inner lining of an artery. As the deposits harden and occlude the arterial lumen, blood flow to distant tissues decreases and a clot may become lodged, completely blocking the artery.
Over time, these plaques can block the arteries and cause heart disease, stroke, and other symptoms or problems throughout the body.
Disorders that are passed down through families often lead to higher cholesterol levels that are harder to control.
Reviewed By
Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Internal review and update on 02/19/2024 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e563-e595. PMID: 30879339. pubmed.ncbi.nlm.nih.gov/30879339/.
Genest J, Mora S, Libby P. Lipoprotein disorders and cardiovascular disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 27.
Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary; a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):3168-3209. PMID: 30423391 pubmed.ncbi.nlm.nih.gov/30423391/.
Robinson JG. Disorders of lipid metabolism. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 190.
US Preventive Services Task Force website. Final recommendation statement. Statin use for the primary prevention of cardiovascular disease in adults: preventive medication. www.uspreventiveservicestaskforce.org/uspstf/recommendation/statin-use-in-adults-preventive-medication. Updated August 23, 2022. Accessed February 16, 2024.
US Preventive Services Task Force website. Final recommendation statement. Lipid disorders in children and adolescents: Screening. www.uspreventiveservicestaskforce.org/uspstf/recommendation/lipid-disorders-in-children-screening. Updated July 18, 2023. Accessed February 16, 2024.